High Dose Rate Brachytherapy for Prostate Cancer
Prostate cancer is very common in the
United States. The prostate is a small
gland sandwiched between the bladder and
rectum. Due to the prostate’s close
proximity to the bladder, urethra,
neurovascular bundles and rectum,
the most common side-effects of any
surgical or radiological treatment
for prostate cancer include urinary,
bowel, and sexual (erectile dysfunction)
side-effects. There are several treatment
options for men that are diagnosed with
prostate cancer. However, preservation
of quality of life should be an important
goal in the treatment strategies used to
treat prostate cancer. In addition to
meeting with an urologist who is a
surgical specialist, it is equally
important to have a consultation with a
radiation oncologist to fully understand
all of the radiation therapy treatment
options available for the treatment of
prostate cancer.
There have been several advances in the delivery
of radiation therapy that have led to increases
in our ability to deliver higher doses of
radiation therapy more safely, thereby
increasing cure rates and quality of life
for our patients. Just as intensity
modulate radiation therapy (IMRT) is a
leap forward in our ability to more effectively
and safely deliver external beam radiation for
the treatment of prostate cancer, high dose rate
(HDR) brachytherapy is a leap forward in the
delivery of precise brachytherapy for prostate cancer.
HDR brachytherapy is the safest, most
technologically advanced method to deliver
a high dose of radiation therapy to
the prostate while minimizing urinary,
bowel, and sexual side-effects.
HDR brachytherapy is most commonly used as
a boost treatment and is combined with an
abbreviated (5-week) course of external
beam radiation therapy in patients who
have intermediate or high risk prostate cancer.
The procedure is performed by a radiation
oncologist and urologist. Flexible afterloading
catheters (15-20 catheters per patient)
are placed using ultrasound guidance
during a brief operating room procedure.
These catheters are placed transperineally
(through the skin between the scrotum and rectum)
directly into the prostate gland.
A CT scan is then performed through
the pelvic region. The images from
the CT scan are used to precisely
contour the outlines of the prostate,
urethra, bladder, and rectum. Using
sophisticated software, a radiation
therapy treatment plan can be designed
to maximize dose to the prostate gland
while minimizing dose to nearby critical
normal structures such as bladder and rectum.
This ability to do precise treatment planning
with CT scan information obtained after the
catheters have been placed makes HDR brachytherapy
one of the most exact and safe methods for
treating prostate cancer.
Once the treatment plan has been
designed and approved by your radiation
oncologist, 2 or 3 HDR brachytherapy
treatments will be delivered in the
radiation oncology department. Each
HDR brachytherapy treatment takes about
5-10 minutes to deliver. The patient
remains in the hospital for 1 night while
the treatments are delivered because each
individual treatment is delivered at least
6 hours apart from other treatment.
There are no residual radioactive
sources or seeds left inside patients
since all the radiation therapy is
delivered during the 5-10 minute HDR
brachytherapy treatment, and there is
zero radiation exposure to family
members or hospital staff.
